Digital Planning Software Fails to Reflect Stem Torsion on Plain Radiographs after Total Hip Arthroplasty

Worlicek, Michael; Weber, Markus; Zeman, Florian; Wörner, Michael; Schneider, M.; Grifka, J.; Renkawitz, Tobias; Craiovan, Benjamin

doi:10.1055/s-0042-106975

Cited by 6 publications

(3 citation statements)

References 10 publications

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“…25 Conventional imaging is not sufficient to accurately predict postoperative prosthetic anteversion. 26 As the cost of a CT scan continues to decrease, the clinical advantages of having a more precise 3-dimensional plan, along with savings obtained from accurate sizing, might offset the initial costs of the preoperative CT. The radiation dose associated with the CT scan required for THR planning averages only 2.8mSv.…”

Section: Discussionmentioning

confidence: 99%

Variation in femoral anteversion in patients requiring total hip replacement

et al. 2019

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Background: Optimal implant alignment is important for total hip replacement (THR) longevity. Femoral stem anteversion is influenced by the native femoral anteversion. Knowing a patient’s femoral morphology is therefore important when planning optimal THR alignment. We investigated variation in femoral anteversion across a patient population requiring THR. Methods: Preoperatively, native femoral neck anteversion was measured from 3-dimensional CT reconstructions in 1215 patients. Results: The median femoral anteversion was 14.4° (−27.1–54.5°, IQR 7.4–20.9°). There were significant gender differences (males 12.7°, females 16.0°; p < 0.0001). Femoral anteversion in males decreased significantly with increasing age. 14% of patients had extreme anteversion (<0° or >30°). Conclusions: This is the largest series investigating native femoral anteversion in a THR population. Patient variation was large and was similar to published findings of a non-THR population. Gender and age-related differences were observed. Native femoral anteversion is patient-specific and should be considered when planning THR.

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Section: Discussionmentioning

confidence: 99%

Variation in femoral anteversion in patients requiring total hip replacement

et al. 2019

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“…In our study, angles of acetabular component position and measurement of leg length using the new software tool were as accurate as of the two widely accepted reference software platforms. When compared relative to a clinically relevant threshold of ±5° or ±5 mm [ 24 ], proportional analyses revealed that for acetabular component orientation and leg length, 100% of the new software’s measurements fell within this threshold, with the only exception being inclination relative to the SRV, which saw 99.3% of inclination measurements fall within 5° of the reference value. Further, 94.4% of anteversion and 95.8% of inclination measurements were within 1° of the PRV measurements, while 90.2% of inclination measurements were within 1° of the SRV measurements.…”

Section: Discussionmentioning

confidence: 99%

Validation of a Novel Software Measurement Tool for Total Hip Arthroplasty

Muir

Foley

Fiaes

et al. 2021

Cureus

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BackgroundPreoperative planning and postoperative evaluation of component position in total hip arthroplasty (THA) utilize specialized software that must be able to provide measurements that are both accurate and precise. A new software program for use in THA has recently been developed. We sought to evaluate the accuracy of this new software in comparison with two current, widely used software programs. MethodologyPostoperative anteroposterior (AP) pelvic radiographs from 135 THA patients were retrospectively reviewed. Reference values for acetabular anteversion, inclination, and leg length were established using validated software programs (TraumaCad ® as the primary reference value [PRV] and OsiriX Lite TM as the secondary reference value [SRV]). Measurements from the new software program (Intellijoint VIEW TM ) were compared with reference values using Student's t-test and chi-square test. ResultsFor anteversion, mean values for the PRV (27.34° ± 7.27°) and the new software (27.29° ± 7.21°) were not significantly different (p = 0.49). The new software differed from the PRV by a mean of 0.05° ± 0.93°. Similar results were noted for inclination, where the new software differed from the PRV and SRV by -0.13° ± 0.65°a nd 0.25° ± 1.26°, respectively (mean values: PRV: 43.62° ± 6.02°; SRV: 43.99° ± 6.27°; new software: 43.74° ± 6.17°; p = 0.87), and for leg length, where the new software differed from the PRV and SRV by 0.05 mm ± 0.46 mm and 0.22 mm ± 0.52 mm, respectively (mean values: PRV: 10.61 mm ± 11.60 mm; SRV: 10.77 mm ± 11.70 mm; new software: 10.56 mm ± 11.61 mm; p = 0.98). Measurements were highly correlated across multiple reviewers (intraclass correlation coefficient ≥0.987). ConclusionsThe new software measurement tool is accurate and precise for assessing the acetabular component position and leg length measurements following THA in AP pelvic radiographs compared to currently used image measurement software.

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“…Through considerable improvements in diagnostic software and hardware, MARS (metal artefact reduction sequence) MRI has recently been shown to present good sensitivity and specificity to detect component loosening [18]. CT scans offer improved resolution and are useful in the analysis of focal osteolysis, deformities such as rotational abnormalities and improved digital planning capacities [19][20][21]. X-ray still present the first imaging step when loosening of hip prosthesis is suspected and present with a decent sensitivity and specificity but are not as specific/sensitive as MRI and CT [22].…”

Section: Discussionmentioning

confidence: 99%

Femoral defects in revision hip arthroplasty: a therapy-oriented classification

Jaenisch

Kohlhof

Kasapovic

et al. 2021

Arch Orthop Trauma Surg

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Introduction The complex field of femoral defects in revision hip arthroplasty displays a lack of standardized, intuitive pre- and intraoperative assessment. To address this issue, the femoral defect classification (FDC) is introduced to offer a reliable, reproducible and an intuitive classification system with a clear therapeutic guideline. Materials and methods The FDC is based on the integrity of the main femoral segments which determine function and structural support. It focuses on the femoral neck, the metaphysis consisting of the greater and lesser trochanter, and the femoral diaphysis. The four main categories determine the location of the defect while subcategories a, b and c are being used to classify the extent of damage in each location. In total, 218 preoperative radiographs were retrospectively graded according to FDC and compared to intraoperatively encountered bone defects. To account for inter-rater and intra-rater agreement, 5 different observers evaluated 80 randomized cases at different points in time. Results A Cohens kappa of 0.832 ± 0.028 could be evaluated, accounting for excellent agreement between preoperative radiographs and intraoperative findings. To account for inter-rater reliability, 80 patients have been evaluated by 5 different observers. Testing for inter-rater reliability, a Fleiss Kappa of 0.688 could be evaluated falling into the good agreement range. When testing for intra-rater reliability, Cohens Kappa of each of the 5 raters has been analyzed and the mean was evaluated at 0.856 accounting for excellent agreement. Conclusion The FDC is a reliable and reproducible classification system. It combines intuitive use and structured design and allows for consistent preoperative planning and intraoperative guidance. A therapeutic algorithm has been created according to current literature and expert opinion. Due to the combination of the FDC with the recently introduced Acetabular Defect Classification (ADC) a structured approach to the entire field of hip revision arthroplasty is now available.

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Digital Planning Software Fails to Reflect Stem Torsion on Plain Radiographs after Total Hip Arthroplasty

Cited by 6 publications

References 10 publications

Variation in femoral anteversion in patients requiring total hip replacement

Variation in femoral anteversion in patients requiring total hip replacement

Validation of a Novel Software Measurement Tool for Total Hip Arthroplasty

Femoral defects in revision hip arthroplasty: a therapy-oriented classification

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